Southard v. Occidental Life Insurance Co. of California

142 N.W.2d 844, 31 Wis. 2d 351, 1966 Wisc. LEXIS 987
CourtWisconsin Supreme Court
DecidedJune 7, 1966
StatusPublished
Cited by24 cases

This text of 142 N.W.2d 844 (Southard v. Occidental Life Insurance Co. of California) is published on Counsel Stack Legal Research, covering Wisconsin Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Southard v. Occidental Life Insurance Co. of California, 142 N.W.2d 844, 31 Wis. 2d 351, 1966 Wisc. LEXIS 987 (Wis. 1966).

Opinion

Hallows, J.

We hold a question of law rather than a question of fact is raised by the affidavits and should *355 be decided upon the defendant’s motion under the rule laid down in Bond v. Harrel (1961), 13 Wis. (2d) 369, 108 N. W. (2d) 552; Rabinovitz v. Travelers Ins. Co. (1960), 11 Wis. (2d) 545, 105 N. W. (2d) 807; and Voysey v. Labisky (1960), 10 Wis. (2d) 274, 103 N. W. (2d) 9. In its affidavit in support of its motion, the defendant sets forth the application and states it relied thereon in insuring Southard. The critical question in the application concerning the applicant’s health asked, “During the last two years have you had heart disease, diabetes, lung disease, cancer or any other serious illness, or received treatment or medication for blood pressure ?” To this inquiry, Southard answered “No.”

From the affidavits it is clear and without dispute that Robert R. Southard severed his spine in a swimming accident in June 1954, that as a result he had a non-functioning nervous system and was partly paralyzed, that the paralysis affected both his arms and legs, making him a quadriplegic, that he had no control of his normal bladder functions and it was necessary to have a cystot-omy tube inserted in his bladder, that this tube caused a chronic cystitis condition which necessitated continual medical treatment for leakage and bleeding around the tube and that from the time of the 1954 swimming accident until his death the applicant was confined to a wheelchair.

The defendant’s affidavit claims this condition was a serious illness and thus the answer in the application was a misrepresentation; and on the contrary the plaintiff’s affidavit claims such condition was not a serious illness, was not considered so by the applicant, and in spite of his handicap the applicant completed his college education at the University of Wisconsin and the Eau Claire State Teacher’s College, established a successful insurance agency in Eau Claire, was president of the Sheltered for Handicapped, Inc., and was chosen Wisconsin’s handicapped person for 1960. The cause of *356 death given in the death certificate was “Pul. [monary] Atelectasis & Pneumonia” with “Quadriplegia” and “Septicemia” as significant conditions contributing to death but not related to the terminal disease.

We hold the applicant did not have a serious illness at the time he made the application for group life insurance coverage. What constitutes a serious illness must be construed in the light of the particular use of the word and in its context. Here, the defendant solicited the application for life insurance by mail and required no physical or medical examination. Only two questions directly relating to insurability were asked. The first inquired whether the applicant had been confined to a hospital or sanitorium within the last two years, to which the applicant answered “No.” The second question, claimed to be falsely answered, asked whether “During the last two years” the applicant “had heart disease, diabetes, lung disease, cancer or any other serious illness, or received treatment or medication for blood pressure ?” Under the familiar canon of construction of ejusdem generis, “other serious illness” would mean an illness of the same general seriousness and classification as cancer, or diabetes, or heart and lung disease. See 17A C. J. S., Contracts, p. 173, sec. 313. These diseases all relate to and seriously affect the general soundness and health of a person and require continuous medical treatment. Quadriplegia is not such an illness, if it is an illness at all. This inquiry in the application relating to insurability is limited and does not cover all illnesses but only serious illnesses of a limited classification. This and the question relating to confinement in a hospital or sanitorium and treatment for blood pressure were all the insurance company was interested in or considered necessary for the type of group life insurance offered. It does not ask whether the applicant was free from any physical impairment, whether he considered himself in good health, or except for blood pressure whether he had *357 received any medical treatment or advice. Obviously the risks assumed under this group plan are greater than those assumed under individual policies requiring more detailed information and a medical examination and presumably the premiums were related and adjusted to the risks thus assumed.

The inquiry in the application called for a layman’s answer, not a medical opinion. An insurer soliciting by mail applications for life insurance from laymer cannot expect medical opinions as answers to inquiries. Conversely, the applicant must make a reasonable use of his faculties in endeavoring to understand and answer the questions asked of him and his answers must be made fairly and in good faith. Nor can an insurer inquire about a few illnesses and expect a complete medical history in response. The questions must “fetch the answer.”

It is no doubt true the applicant’s condition was material to the risk in the sense it would have influenced an insurance company in its rejection of the application. However, such relationship does not necessarily make the applicant’s condition an illness. There can be healthy handicapped people.

True, quadriplegia is a serious physical impairment but so is the loss of a limb, or blindness, or total deafness. But such handicaps are not commonly thought of as illnesses even though they may possibly tend to shorten the span of life by increasing the risk of accidental death. A tube in a bladder to aid its functioning would seem to be a condition or an aid to a physical impairment, not an illness. If the existence of the tube constitutes an illness because it aids the functioning of the human body, then other aids like glasses and hearing aids must be considered indicia of an illness, but obviously this is not true.

In Schneider v. Wisconsin Life Ins. Co. (1956), 273 Wis. 105, 113, 76 N. W. (2d) 586, this court approved the definition of the term “illness” as, “Within the *358 meaning of a statement by an applicant in such respect, the term ‘illness’ means a disease or ailment which is of such a character as to affect the general soundness and healthfulness of the system seriously, and not a mere temporary indisposition which does not tend to undermine and weaken the constitution.” This definition was taken from 29 Am. Jur., Insurance, pp. 1005, 1006, sec. 745. See also Anno. 153 A. L. R. 709, which states “serious illness” or “disease” means only such illnesses or diseases as are likely to be attained by a permanent or material impairment of the health or constitution and do not include such as are merely temporary in duration and the effect of which has entirely passed away. As lay persons use the term “illness,” Southard may have been seriously handicapped but he had no serious illness.

Even though the applicant’s handicap was not a serious illness, the question arises whether he was under a duty to disclose it because as an insurance man he must have known it was material to the risk. The trial court was of the opinion Southard had a duty to disclose his condition because contracts of insurance are traditionally uberrimae fidei, relying on

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Bluebook (online)
142 N.W.2d 844, 31 Wis. 2d 351, 1966 Wisc. LEXIS 987, Counsel Stack Legal Research, https://law.counselstack.com/opinion/southard-v-occidental-life-insurance-co-of-california-wis-1966.